Welcome to The Partnership to Empower Physician-Led Care weekly newsletter, which includes news from our members, legislative and Administration updates, news clips, and studies about value-based care, primary care, and independent physicians.
PEPC: (9/6) – PEPC was pleased to provide comment on the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (PFS) proposed rule. In the response, PEPC expressed appreciation for the steps taken by the Centers for Medicare and Medicaid Services (CMS) to support independent practices and providers entering value-based care models. PEPC encouraged CMS to consider additional steps to further encourage physicians to move away from fee-for-service (FFS) delivery models, and urged CMS to ensure that Part B reimbursement is a sustainable platform for models that continue to be built off the FFS chassis. We also applauded CMS for many of the proposed changes to the Medicare Shared Savings Program (MSSP), and noted additional opportunities to strengthen the program to ensure participation by independent practices and physicians.
PEPC: (8/31) – PEPC responded to CMS’ Request for Information (RFI) on Medicare Advantage (MA). PEPC outlined key factors for successful value-based care arrangements, including standardization, transparency, and aligned incentives. We also asked CMS to consider implementing policies to require MA plans to offer advance investment payments to physician-led models, harmonize quality measures across programs, and test more multi-payer models to double down on synergies across markets.
CMS: (9/6) – On September 6, CMS released the Make Your Voices Heard RFI to collect feedback on how to best support the Administration’s ongoing work to advance health equity and reduce disparities. In particular, CMS seeks public input on accessing health care and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency (PHE). Comments are due on November 4th.
House of Representatives: (9/7) – Rep. Doggett (D-TX), Rep. Pramila Jayapal (D-WA), and Rep. Jan Schakowsky (D-IL), along with 28 other Democratic Members of Congress, released their response to CMS’ RFI on MA. The letter calls for CMS to prevent delays and medically unnecessary restrictions to accessing care, rein in MA marketing tactics, make change to risk adjustment to reduce overpayments to MA plans, and terminate the ACO REACH program. Press Release
AAFP, MGMA: (8/30) – AAFP, MGMA, and partner organizations submitted comments on the CY 2023 Medicare PFS proposed rule. The groups urged CMS to consider additional opportunities for ACOs to participate in advanced investment payments, refocus the high and low revenue distinction to address the characteristics of beneficiaries served by an ACO, allow existing ACOs to opt-in to new payment approaches, engage stakeholders in designing benchmarks for the future, reconsider the timeline for requiring electronic clinical quality measures (eCQM) reporting and limit reporting to the ACO population, support an extension of the Advanced APM bonuses, and utilize MSSP as an innovation platform.
Aledade: (8/30) – In a recent blog post, Aledade CEO, Dr. Farzad Mostashari, shared his initial thoughts on the final results for MSSP in Performance Year (PY) 2021. Dr. Mostashari reflected that MSSP is strong, resilient, and delivering results for patients, doctors, and the entire nation. Last year, Aledade ACOs saved the Medicare program more than $390 million and four of the top 10 ACOs in MSSP were Aledade ACOs.
Health Affairs: (9/6) – In this study, researchers found that low-value care and associated spending remain prevalent among commercially insured and MA enrollees. The aggregated prevalence of twenty-three low-value services was 1,920 per 100,000 eligible enrollees, which amounted to $3.7 billion in wasteful expenditures from 2009 to 2019. State-level variation in spending was greater than variation in utilization, and much of the variation in spending was driven by differences in average procedure prices.
Health Affairs: (9/6) – The Comprehensive Primary Care Plus (CPC+), a previous Center for Medicare and Medicaid Innovation (CMMI) model, was a national advanced primary care medical home model that aimed to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. In this recent study, researchers found that CPC+ did not improve spending or quality for private-plan enrollees in Michigan, even before accounting for payouts to providers, adding to existing evidence that CPC+ may cost payers money in the short term, without concomitant improvements to care quality.
Forbes: (9/6) – This two-part article addresses the importance of primary care, why investors believe now is the time to bet on primary care, key players, and the future of primary care. While traditionally underinvested, earlier this year researchers found that companies innovating in primary care had raised $16 billion in 2021 alone. Much of the investor enthusiasm is for a new category: “payviders,” who contract with MA plan sponsors or with Medicare directly and receive a fixed fee for all care they provide to a population for a given year. To be successful, the author says these organizations must successfully integrate technology into their practice and patient relationships for the purpose of tightening the very human bonds and further fostering those human connections.
STAT News: (9/6) – In this article, the author reflects on the common themes in response to the MA RFI, which received roughly 4,000 responses. The article outlines three primary buckets of topics covered, including prior authorization, network adequacy, and risk adjustment. The feedback on the MA RFI could influence how CMS approaches regulations for 2024, which will come out in February.
Modern Healthcare: (9/6) – More than 740 health care private equity deals occurred in health care services in the first half of the year, down 20 percent from the same period in 2021 but an increase of 16 percent from 2019. Investors today are increasingly interested in higher-level care services including cardiology, neurology, radiology, and orthopedics. The authors note that any ability to include or have a value-based component around those practices is very attractive to private equity firms.
Modern Healthcare: (9/5) – In this opinion piece, the author offers a physician’s perspective on how providing episodic, fee-for-service care contributes to burnout and suggests that providing value-based (or patient-based) care is a solution. The author notes that value-based care solutions are the first step to recognizing that change is needed and require business and academic leaders, technology solutions, payers and policymakers to be successful.
JAMA: (9/2) – According to this JAMA study, 578 physician practices in dermatology, gastroenterology, and ophthalmology found that acquisition by private equity was associated with increases in health care spending and several measures of utilization, as well as some evidence of greater intensity of care. Taken together, the researchers conclude that these results support the business strategies that private equity firms may pursue in physician practice markets.
Medical Economics: (8/31) – Because of the primary care physician shortage and increased administrative burden that make it more difficult, and costly, for patients to see a primary care doctor, patient behavior is changing. This demand is rapidly changing primary care, driving retailers like CVS and Walmart to get into the primary care game by opening clinics and care being provided by non-physicians, including nurse practitioners and physician assistants. The authors argue that physicians must accept this change and recognize that health care is changing, and old-style hierarchical models are being replaced to put patients, not a single health care profession, at the center of the health care team.
STAT News: (8/31) – Throughout the pandemic, while hospitals received billions in government aid, the pursuit of mergers and acquisitions by the wealthiest health systems continued. Hospitals are continuing to charge higher prices to commercial insurers and Medicare recently granted hospitals the largest price increase since 1998. However, the authors of this article argue that large urban hospitals and wealthy health systems have more than enough money. Employers, employees and taxpayers must demand that those funds be effectively managed to the benefit of the American public by redirecting existing resources and holding the industry accountable for providing high-quality, equitable, and evidence-based care.